center for the advancement of cancer survivorship, navigation and policy elevating patient...

Center for the Advancement of Cancer Survivorship, Navigation and Policy

Elevating Patient Navigation Practice & Policies

Mandi Pratt-Chapman, MA

Director, GW Cancer Institute

July 23, 2015

Patient-Centered Education & Research Institute


Key Points

• Identify importance of competencies in health professions

• Describe process of developing consensus-based competencies for patient navigators

• Identify examples of core competencies for patient navigators

• Access resources to build competencies


Lack of Role Clarity and Standardization

CHW Case

Manager

Social Worker

Nurse

Navigato

rPatient Navigator

Willis, Pratt-Chapman, Reed & Hatcher. JONS. 2014.


Why competencies?

• Creates professional standards• Provides framework for training• Clarifies function and importance to

– Grantors– Organizations– Payors– Policymakers


Competency and Training Development

Identify roles & responsibilities

Write competencies

Create training


Competency and Training Development

Academy of Oncology Nurse

& Patient Navigators

Oncology Nursing Society

National Association of Social Workers

Association of Oncology Social

Workers

Association of Community

Cancer Centers

Patient navigators and

CHWs


1) Identify Roles and Responsibilities

Patient navigation training curricula

Journal articles on roles/ responsibilities/ competencies/ tasks/ activities for CHWs, patient navigators, nurse/social worker navigators

CHW, nurse navigator competencies


Functional Domains

Professional Roles/

ResponsibilitiesCommunication Patient

Empowerment Cultural competency

Ethics & Professional Conduct

Education, Prevention & Health

Promotion

Psychosocial Support Services /

Assessment

Barriers to Care / Health Disparities

Community Resources Outreach Care Coordination Advocacy

Willis, Reed E, Pratt-Chapman, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washingtion E. JONS. 2013.


Oncology Navigation Roles

DomainCommunity Health Worker Patient Navigator

Clinical Navigator (RN/SW)

Barriers to Care/Health Disparities: Identifying and addressing barriers to care and reducing health disparities as defined by age, disability, education, ethnicity, gender, sexual identification, geographic location, income or race that often bear the greater burden of disease than general population.

Address barriers to accessing the health care system. Focus on reduction of general health disparities.

Address structural, cultural, social, emotional and administrative barriers to care. Focus on reduction of cancer health disparities in medically underserved patients and timely access to care across the continuum.

Address clinical and service delivery barriers to care. Provision of services to at-risk populations which may be defined by individual need, high-acuity or high-volume at institutional level.

RN = registered nurse; SW = social worker; Dx = diagnostic; Tx = treatment.



Oncology Navigation Roles

DomainCommunity Health Worker Patient Navigator

Clinical Navigator (RN/SW)

Patient empowerment: Identifying problems and resources to help patients solve problems and be part of the decision-making process.11

An important facilitator of patient empowerment is development of good patient rapport.

Motivate individual and community to make positive changes in health behaviors.

Activate and empower individuals and communities to self-advocate and make healthy decisions.

Assist patient with identifying administrative, structural, social, and practical issues to participate in decision-making and solutions.

Empower patients by ensuring they know all their options; identify their preferences and priorities, and assist them to access healthcare services and self-manage their health.

Educate patients on their rights and preferences and ensure they are able to participate in the decision-making process throughout their care and into survivorship or end-of-life care.

Assist patients in decision-making regarding diagnostic testing and treatment options (specific to nurse navigators).

Provide patients with strategies to cope with disease, treatment, and stress (specific to social work navigators).



Focus Group Demographics

We hosted 6 focus groups (N=21). Majority:• Were female (N=19)• Were ages 55-64 (N=8) and 25-34 (N=5)• Were White (N=13) and/or non-Hispanic/Latino (N=16)• Held Bachelors (N=8) or Masters degrees (N=8)• Had varying years of experience from less than 1 to

more than 10• Worked in multiple settings (N=6) and community

organizations (N=5)• Were from GA (N=3), HI (N=3), or DC/MD/VA (N=4)


Asking Patient Navigators

Advocacy

Barriers

Basic skills

Care coordination

Communication

Cultural sensitivity

Ethics

Evaluation

Patient assessment

Patient education

Program development

Resources

Role delineation


2) Write Competencies

• Team wrote them• Experts reviewed them• National survey with 65 competencies• 618 consented; 525 respondents eligible


Professions Represented

Repondents

Nurse NavigatorPatient NavigatorNavigation SupervisorSocial WorkerResearcherCHWOther


Competency DomainsPatient Care (6)

Knowledge for Practice (6)

Practice-Based Learning (7)

Interpersonal and Communication Skills (8)

Professionalism (8)

Systems-Based Practice (3)

Interprofessional Collaboration (3)

Personal and Professional Development (4)


“Shared language is important in leading adaptive change. When people begin to use the same words with the same meaning, they communicate more effectively, minimize misunderstandings, and gain the sense of being on the same page, even while grappling with significant differences on the issues.”Heifetz R et al. The Practice of Adaptive Leadership, 2009.


Refining Competencies

Identified statements with lowest

endorsement

Assessed qualitative feedback

Refined and collapsed

statements


Sample Competency

•Patient CareDomain

•Facilitate patient-centered care that is compassionate, appropriate and effective for the treatment of cancer and the promotion of health.

Overarching Competency

•Assist patients in accessing cancer care and navigating health care systems. Assess barriers to care and engage patients and families in creating potential solutions to financial, practical and social challenges.

Competency


Sample Competency

•Knowledge for PracticeDomain

•Demonstrate basic understanding of cancer, health care systems and how patients access care and services across the cancer continuum to support and assist patients.


•Demonstrate basic knowledge of medical and cancer terminology.

Competency


Sample Competency

• Practice-Based Learning and ImprovementDomain

• Improve patient navigation process through continual self-evaluation and quality improvement. Promote and advance the profession.


•Use evaluation data (barriers to care, patient encounters, resource provision, population health disparities data and quality indicators) to collaboratively improve navigation process and participate in quality improvement.

Competency


Sample Competency

•Interpersonal & Communication SkillsDomain

•Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and health professionals.


•Employ active listening and remain solutions-oriented in interactions with patients, families and members of the health care team.

Competency


Sample Competency

•ProfessionalismDomain

•Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principals.


•Apply knowledge of the difference in roles between clinically licensed and non-licensed professionals and act within professional boundaries.

Competency


Sample Competency

•Systems-Based PracticeDomain

•Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.


•Organize and prioritize resources to optimize access to care across the cancer continuum for the most vulnerable patients.

Competency


Sample Competency

•Interprofessional CollaborationDomain

•Demonstrate ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care.


•Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity and trust.

Competency


Sample Competency

•Personal and Professional DevelopmentDomain

•Demonstrate qualities required to sustain lifelong personal and professional growth.


•Set learning and improvement goals. Identify and perform learning activities that address one’s gaps in knowledge, skills attitudes and abilities.

Competency


3) Create Competency-Based Training

• Accessible: Free and online • Competency-based: All competencies

addressed through adult learning methods• Supported by cooperative agreement

#1U38DP004972-01 from the Centers for Disease Control and Prevention

• Launch: May 2015


www.cancercontroltap.org


Oncology Patient Navigator Training: The Fundamentals

•Introduction to the Online Academy•Overview of Patient Navigation (History, Model)

Introduction

•Medical Terminology•Cancer Basics•Clinical Trials•US Health Care System•Health Care Payment Financing

Basics of Health Care

•Role of the Patient Navigator•Patient Assessment•Shared Decision Making•Identifying Resources

Basics of Patient Navigation


Oncology Patient Navigator Training: The Fundamentals (cont.)

•Communicating with Patients•Patient Advocacy•Cultural Competency

Enhancing Communication

•Scope of Practice•Ethics and Patient Rights

Professionalism

•Practicing Efficiently and Effectively•Health Care Team Collaboration•Program Evaluation & Quality Improvement•Personal & Professional Development

Enhancing Practice


GW Cancer Institute Publications

• Pratt-Chapman M, Willis A. Community Cancer Center Administration and Support for Navigation Services. Seminars in Oncology Nursing. 2013;29(2):141-148.

• Willis A, Reed, Pratt-Chapman M, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washington E-C. Development of a Framework for Patient Navigation: Delineating Roles Across Navigator Types. Journal of Oncology Navigation and Survivorship. 2013;4(6):20-26.

• Willis A, Pratt-Chapman M, et al. Best Practices in Patient Navigation and Cancer Survivorship: Moving Toward Quality Patient-Centered Care. Journal of Oncology Navigation and Survivorship. 2014.


Additional References

• Association for Prevention Teaching and Research. Competency-to-curriculum toolkit. 2008.

• Englander et al. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine. 2013.

• Heifetz R et al. Leadership in (permanent) crisis. The Practice of Adaptive Leadership, 2009.

• Oncology Nursing Society. Oncology Nurse Navigator Core Competencies. 2013.


Take Home Messages

• Role clarity and standardization is critical for the advancement of patient navigation

• Competencies help define roles and optimize team-based care

• Resources are available to build core competencies in navigation


Acknowledgements

• The Avon Foundation for Women partially supported the development of our framework and competencies.

• The Centers for Disease Control and Prevention funds our current development of an online patient navigation training & toolkit for states as well as the online executive training.


Steering Committee for Functional Domains

• Jennifer Bires, LICSW, OSW-C, Association of Oncology Social Workers• Susan Bowman, RN, OCN, CBCN, MSW, Oncology Nursing Society• Stacy Collins, MSW, National Association of Social Workers• Margaret Darling, Nueva Vida• Leigh Ann Eagle, MAC Inc• Lorena Gayton, City of Hope• Linda Paige, Moffitt Cancer Center• Ana Quijada, Nueva Vida• Fedra Sanchez, Nueva Vida• Lillie Shockney, RN, BS, MAS, Academy of Oncology Nurse & Patient Navigators• David Trejo, City of Hope• Virginia Vaitones, MSW, OSW-C, Association of Community Cancer Centers• Etta-Cheri Washington, Capital City Area Health Education Center• Coni Williams, MS, University of South Florida


Competency Reviewers• Amanda Allison• Susan Bowman, RN, OCN, CBCN, MSW• Elizabeth Clark, PhD, MPH, MSW• Margaret Darling• Andrea Dwyer, MSW• Ginny Pate• Angela Patterson• Terri Salter, RN, MSN, MBA• Karen Schwaderer, RN, BSN, OCN• Lillie Shockney, RN, BS, MAS• Patricia Valverde, PhD, MPH • Etta-Cheri Washington


GW Cancer Institute Staff

PI: Mandi Pratt-Chapman, MA

Research Team: • Anne Willis, MA• Kanako Kashima• Shaira Morales• Monique House, MS, CHES• Adrienne Thomas, LGSW• Elizabeth Hatcher, RN, BSN

Former staff:• Elisabeth Reed, MPA• Heather Kapp, LICSW


Questions & Answers

Mandi Pratt-Chapman

[email protected]

202-994-5502

mailto:[email protected]

center for the advancement of cancer survivorship, navigation and policy elevating patient...

Documents

training slide

policy competency

nurse navigator competencies

chws slide

importance of competencies

gw cancer institute

health care system

health professions